Due to the stigmatization attached to psychological disorders,
people are embarrassed and afraid to seek help. Psychological disorders are
illnesses and are no different than other diseases such as cancer, diabetes,
heart conditions, etc.. Psychological disorders (particularly bipolar disorder)
have been proven to be treatable with medication and/or psychotherapy. With
proper treatment, a person with a psychological disorder can live a manageable,
functional life. Everyone some time or another experiences depression and
according to Ronald Fieve, About 3% to 4% of the population experiences major
depression. Manic depression occurs in 1% or 2%, and another 5% of the population
suffers from one of the other forms of depression. All told, about 10% of
the population is afflicted by depression in one form or another, with women
about two to five times more likely than men to be affected. Manic depression,
however, afflicts men and women equally (Fieve 33-34). According to Fieve's
statistics, a total of 10% of our population suffers from some form of depression.
It is unfortunate for those who are in that 10% range.

Think how hard it must be for a depressed individual to live
day-by-day, not knowing what the next day will be like for them. My questions
would be: "How does a depressed person know they are experiencing depression?
How does this person know what they are feeling is "abnormal?" The symptoms
of depression can become overwhelming to the point that a person may consider
or commit suicide. Depression can include some or all of the following symptoms:
feeling sad, empty, no interest in life, the inability to find pleasure in
activities that used to be enjoyable, weight loss and gain, excessive sleeping
or insomnia, feelings of hopelessness, guilt, trouble concentrating, not able
to focus, can't make decisions, no energy, anxiety, thoughts of death and
not wanting to live (Fieve 21). A person who suffers from depression may suffer
from these symptoms on a come-and-go basis. Sometimes the symptoms may last
longer than other times. The duration of the episodes may vary. Sometimes
they last so long that a person doesn't and cannot get out of bed. They have
absolutely no interest or ambition to do anything. A person may start to realize
that these symptoms are not normal and may not seek help due to the stigma
attached to mental illness.

There are different kinds of depression. There is reactive
depression, which is what a person experiences when mourning someone's death.
Major depression can have episodes and lasts about 2 weeks alternating with
normal periods. Dysthymia depression is mild but present most of the time
lasting for at least 2 years. Finally there are manic depressive disorders
classified as bipolar I and bipolar II (Fieve 22). Bipolar I is a major depression
alternating with periods of manic highs, which can require hospitalization.
When a person is in their mania state and the elation is severe, they are
diagnosed as a bipolar I patient. Bipolar II involves periods of major depression
also mixed in with manic, hypomanic, or mild periods of elation. The difference
between bipolar I and bipolar II is that bipolar I patients suffer from extreme
feelings of elation and bipolar II patients suffer from extreme feelings of
depression (Fieve 22).

According to Ronald Fieve, Hypomanic patients become overactive
socially, physically, and sexually. Characteristically tireless in energy,
they may be garrulous and expansive, charming, and irritable or cracking risque
jokes. During a full manic episode, into which the hypomanic state sometimes
grows, the increased energy is extreme. People experiencing this manic state
may literally go for two or three days without sleep at all. Hypomanic people,
who usually require only four or five hours of sleep, are constantly busy,
talking, telephoning, faxing, planning, and implementing numerous schemes
(Fieve 29). A person can experience two kinds of hypomania. They can experience
either euphoria or dysphoria. Euphoria is grandiosity, feeling in love with
the world, having endless energy. Dysphoria is when one is in a "high" but
is destructive, paranoid, full of anxiety, panic stricken and can lead to
the depressive side. (On-Line Moodswing.org.bdfag.html p. 12).

The "mania" mood is not your average high of happiness. It
is very similar to hypomania, but the person can be hospitalized because the
mania gets to an extreme where it is out of control. Mania is excessive grandiosity,
reduced need for sleep, excessive talkativeness, telephoning, spending, constant
flow of thoughts, inability to concentrate, increase in social activities,
and poor judgment (Fieve 31-32). Individuals affected with the bipolar disorder
may suffer one episode of mania and depression in their lifetime, but this
is usually not the case. Over 95% of people with bipolar disorder have recurrent
episodes throughout their lives. As the illness progresses, individuals tend
to spend more time ill and less time well. It has been reported that 25% of
the individuals have attempted suicide (Basco 2).

Baron Shopsin breaks down the classic symptoms of mania
into three groups: 1) Mood, 2) Behavior and 3) Mentation and Speech. Mood
symptoms can be the following: expansive or infectious, elation, euphoria,
mood usually consistent with ideation, humorous, may be irritable and argumentative.
Behavior symptoms include grandiose acts, need of little sleep, socially active
(generally overinvolved), sexually overactive (females), ambitious (excessive
planning), and increased motor activity (physical hyperactivity). Mentation
and speech symptoms could be any of the following: flight of idea, pressure
of speech, voluminous details (circumstantial), distractibility, humor, illusions,
and grandiosity (Shopsin 58). The question to all of this is what exactly
causes depression and bipolar disorder?

Francis Mondimore postulated the biochemical theory that
a lack of Norepinephrine causes a person to be depressed and that their level
of Acetylcholine is very high. On the other side of the spectrum, when Norepinephrine
is at a very high level, their state is a manic state and their level of Acetylcholine
is very low. (See Illustration #1). The medication Lithium is used to treat
both the depressed state and the manic state. It does not treat the level
of neurotransmitters, but rather it treats the mechanism that determines how
to release these neurotransmitters. (Mondimore 1990). A similar theory claims
bipolar is caused by an imbalance in the number of small amino acid molecules,
called neurotransmitters, that travel between nerves across the synapses in
the brain. Synapses are the spaces between two successive nerve fibers.

There are three major neurotransmitters: norepinephrine (NE),
serotonin (SE), and dopamine (DA). These neurotransmitters enter the synapses.
If one or more of these enter the synapses this can lead to mania, and in
reverse, if one or more of these don't enter the synapses, this leads to depression
(Fieve 45-46). It is believed that this disorder has a biological basis that
is inherited and stress triggers the mood swings (Emery 20). Is bipolar disorder
inherited? There have been many studies and according to Korff Leonhard's
family study, there is an increased incidence of psychosis and suicide in
the families with bipolar I or II compared to the families with unipolar.
In a study conducted by Thus Perris, he studied 138 bipolar, 137 unipolar
depressives, and 17 unipolar manics who had been hospitalized. There was at
least one relative interviewed for each patient. He found that 11% of the
bipolar relatives had bipolar illness and only 0.5% had unipolar illness.
For the unipolar relatives, he found that unipolar hereditary occurred in
7% and bipolar hereditary occurred in 0.4% (Fieve, Dunner 149-50).

There are least two potential sources of evidence for the
physiological basis of depression; genetic data and biochemical evidence.
According to George Winokur and his colleagues, bipolar depression is due
to a dominant gene of the X chromosome. The X chromosome is one of two chromosomes
that, taken together, determine sex. There are 46 chromosomes in humans, or
23 pairs. Women have an XX or a similar pair of sex chromosomes; men have
a dissimilar pair, XY. If a gene is dominant, it will be independent of the
other gene with which it is paired. The mother always contributes an X chromosome
to the offsprings, the father an X or a Y. If the father contributes an X
chromosome, the child will be a girl; if a Y, the child will be a boy. Winokur
separated the patients into two groups, those whose families had affective
disorders and those whose families did not. For those who were in the bipolar
group were at high risk of bipolar depression. He found that female relatives
were much more likely to be depressed than male relatives. This would support
Winokur's prediction that bipolar depression is regulated by a dominant gene
on the X chromosome. In his study, it turned out that the gene that causes
manic-depression in a father is an X chromosome. If the father only passes
on his Y chromosome, he cannot transport bipolar to his son. Overall, he suggests
that the bipolar affective disorders are sex-linked on the X chromosome and
are genetically transmitted (Endler 120).

There are two theories discussed by Norman Endler in reference
to biochemical factors. He believes that depression is due to low levels of
norepinephrine and/or low levels of serotonin at the synaptic gap. The norepinephrine
theory also suggests that mania is due to an excess of norepinephine. Both
norepinephrine and serotonin are neurotransmitters. Affective disorders are
physical, metabolic, and biochemical disturbances of the nervous system. These
disturbances produce changes in the brain which produce changes in moods,
perception, cognition, reasoning ability and behavior. Primary chemical depressions
are basically different from the secondary depressions that are due to stress
or caused by neurosis. Therefore, a correct and precise diagnosis is essential.
From the above research, it is evident that there is some kind of genetic
chemical imbalance that occurs in patients with psychological disorders. Therefore,
bipolar disorder is just like any other "physical" disease. It is out of a
person's control. The part that a person can control is the ability to seek
treatment and get help just just like a patient who has cancer goes for chemotherapy
treatment.

What kinds of pharmacotherapy treatments are there for bipolar
disorder? There are three types of medications commonly used to treat bipolar:
mood stabilizers, antidepressants, and antipsychotics. According to Millie
Niss, mood stabilizers seem to be the primary treatment for most people since
they level a person's moods. Millie claims, "Lithium is the most common mood
stabilizer and is the oldest." The problem with lithium is that there are
side effects which include the following: lethargy, diarrhea, nausea, frequent
urination, tremor, and weight gain. Frequent blood tests are necessary so
that your therapeutic blood level can be maintained. Liver, kidney, and thyroid
functions can also be damaged by long-term use. The other mood stabilizers
are anticonvulsants, which are used primarily to treat epilepsy. These include
Depakote, Depakene, Epival, Tegretol. Lithium has done quite well with many
people and Lithium plus an antidepressant has worked well too (On-Line, Bipolar
Disorder FAQ). According to Mohammed Abou-Saleh, studies have reported a favorable
response to lithium of those whose family history that contained bipolar illness
(Abou-Saleh 120) Depending on the severity of a bipolar's condition, antidepressants
alone can be the solution for some bipolar patients.

However, doctors have to be careful in prescribing these
drugs. They not only can take a person from a depressed state to a normal
state, but they could cause a person who is in the mania state to go into
a hypermania state. This could be very dangerous because this drug helps a
person go from a depressed state to a normal state, and now the patient has
to be concerned with going into a hypermania state. This is just one of the
difficulties. It is a very hard illness to treat. If a bipolar person is already
in hypomania or mania, an antidepressant can induce their condition. To avoid
this a doctor will prescribe an antidepressant plus a mood stabilizer. Antidepressants
medications are the following: Prozac, Paxil, Zoloft, Luvox, Effexor, Norpramin,
Sinequan, Elavil, Anafranil, Doxepin, Nardil, Parnate. Some of the side effects
include: dry mouth, tremor, nausea, insomnia, drowsiness, anxiety, hypomania,
sexual dysfunction (Bipolar Disorder, FAQ). It is no wonder why an affected
person would refuse to take medication. There are just too many side effects
and other issues that arrise. Antipsychotics are major tranquilizers and are
used to calm people down. Bipolar patients are given this kind of drug when
waiting for a mood stabilizer to become therapeutic. These include: Thorazine,
Mellaril, Stelazine, Haldol, Risperdal, Clozaril, Trilafon. Antipsychotic
side effects can include: sleepiness, slowed speech and thinking, difficulty
walking or with balance, restlessness, twitching, involuntary movements, confusion,
stiffness (Bipolar Disorder, FAQ).

According to Ronald Fieve, antiepileptic medications have
been used such as Tegretol or Depakote in place of lithium when lithium has
not been successful for certain patients (Fieve, 5). According to Gary Emery,
"A drug, lithium, can control this disorder, but since there seems to be a
psychological as well as a physical components to the problem, the best treatment
is often a combination of lithium and psychotherapy." Drugs help the physical
problems, but what about the psychological problems that exist? These too
need to be addressed. This is why psychotherapy in conjunction with medication
is important. Drugs have been criticized because they are only a temporary
cure for the problem and people don't look at what's wrong with their life
and the changes needed to ensure their mental health. Instead, they become
dependent on drugs. To attempt to control the course of this illness, pharmacotherapy
treatment is needed though it may not altogether eliminate recurrences of
mania or depression. It does however decrease the chances, frequency, and
severity of both the depression and mania states. This improves the patients
psychosocial functioning (Basco 2). The major problem is that patients do
not take their medications regularly.

There is a psychotherapeutic treatment called Cognitive-Behavioral
Therapy (CBT) that can enhance medical management so that patients can identify
symptoms in their early stages which could prevent a full relapse or a recurrence
of a new episode. According to Basco, In a 12-month study of the maintenance
treatment of bipolar disorder, Davenport, Ebert, Adland, and Goodwin (1977)
found that patients assigned to a couples psychotherapy group had fewer instances
of rehospititalization and few marital failures, as well as better social
functioning and family interaction, than did patients in a lithium maintenance
group or community-based after care. In addition to this 12-month study, there
have been other long- and short-term group therapies combined with pharmacotherapy,
that have been found to reduce the frequency, length, and severity of the
episodes. The affective, cognitive, and physiological changes in depression
and mania lead to behavioral responses that can create problems for patients
such as stress. CBT for the maintenance phase treatment of bipolar disorder
augments rather than replaces the pharmacological management of this illness.
The CBT techniques provide patients with additional coping strategies when
medication alone is not enough (Basco 4-8). See Illustration #2. In one particular
case a woman named Ms. Galindo moods' changed from week to week, even though
she was on medication. CBT is based on the notion that feelings, thoughts,
and behaviors are interrelated and they influence one another. For example,
when Ms. Galindo felt blue (these were her feelings), she reminisced about
the past. She thought about the mistakes she had made and the people she had
hurt (these were her thoughts), and she felt hopeless so she would isolate
herself from work, friends, and family (this was her behavior). But with CBT,
patients are taught to recognize the affective, cognitive, and behavioral
patterns that make their symptoms worse. Once the pattern is recognized, CBT
techniques can be used to "break the cycle" by modifying cognitive or behavioral
responses. These detected symptoms detected can serve as cues to seek better
medication and control feelings the patient is experiencing (Basco 9-10).

According to Emery, psychological treatment can be broken
down into three types: traditional or insight, behavioral, and cognitive.
Insight therapy helps you understand your problems. This could focus on your
childhood experiences, and maybe it's these experiences that cause your depression.
It could also be focusing on your true feelings i.e., you're depressed, but
in actuality you are angry at someone else and turn the feelings inward and
become depressed. Behavior therapy believes that your depression is caused
by too many unpleasant experiences and the solution is to increase pleasant
experiences by solving unpleasant experiences. Cognitive therapy teaches a
person to identify, correct, and "reality-test" cognitive distortions. "Cognitive
therapy is brief, directive, and highly structured. The person first learns
how to obtain relief from the symptoms; later she learns how to identify and
change the dysfunctional beliefs that led her to distort her experiences in
the first place" (Emery, 22-23). It appears that psychological treatment is
an essential piece of the treatment. Depending on how severe a person's condition,
some people may be able to survive and live a normal fulfilling life by obtaining
psychotherapy without medication.

The thing to remember is that bipolar disorders are life
long, chronic medical conditions. They are not curable but are treatable and
can be managed. According to Barry Campbell, "Bipolar Disorder is a lifelong,
chronic medical condition. It cannot be cured, but it can in almost all cases
be managed to at least some extent" (On-Line Services FAQ). The biggest problem
with the disorder is that manic patients are in denial that they are ill and
refuse to get professional help. They are afraid. They must accept their illness
before they can help themselves. They are too concerned about how they will
be perceived by our society since there is a "stigma" attached to psychological
illnesses. Norman Endler, in Holiday of Darkness, gives his personal journey
of his life with depression. He suffered from bipolar affective disorder.
He wound up using many forms of treatment such as drugs, electroshock therapy
(ECT), and psychotherapy. Although ECT is probably the most effective method
of treating depression, it is not used as frequently as drugs because of sociopolitical
and practical factors. ECT is the treatment of choice of many moderate depressions
and for all severe ones. Clinical studies have shown that ECT is the most
reliable, effective, and convenient technique for alleviating disabling and/or
intense depression. ECT was basically effective because it induced a convulsion
and because of the methodology used. Thereafter, it became a highly sophisticated
technique and was not a horrific experience anymore. ECT is best for severe
bipolar and unipolar affective disorders. After three or four treatments the
depression starts lifting, and all that is necessary, as a rule, is a course
of 6 to 12 treatments. Manic reactions of a bipolar illness can also be treated
effectively with ECT, although lithium is preferred. Lithium is known as a
prophylactic against manic-depression. It is not a traumatic nor an unpleasant
treatment. It is recommended today that after ECT treatment, a patient should
be placed on a drug treatment program.

Norman Endler's experience with ECT turned out to be a success.
He had many fears of memory loss and was concerned it could make his condition
worse. After two weeks, he had gone from feeling like an emotional cripple
to feeling well. He felt like he was on top of the world. ECT did not work
for him when he had his next episode of depression. After trying many different
medications and ECT treatments, his doctor prescribed Lithium to him. In conclusion,
his first depression was alleviated dramatically and instantaneously by ECT.
His second depression took much longer to dissipate. At the time he was writing
his book, he was still taking a dose of Lithium of 600 mg a day. He thought
that he may have to take Lithium for the rest of his life just like a diabetic
takes insulin the rest of their life. Lithium acts like a fine-tuner mechanism.
It fine tunes the moods. If they are too high, it helps to lower them. If
they are too low, it helps to raise them. Norman Endler said, "The prospect
of having to take lithium for the rest of my life is a small price to pay
for being my old cheerful, easy-going, self again." Psychotherapy may
be a useful therapeutic supplement to ECT and antidepressants. Lithium plays
a useful role in treating the bipolar affective disorder and can serve as
a prophylactic (prevention) against recurrences. Norman Endler indicates that
his illness was biochemically induced and not due to his childhood or other
trauma. When he finished his book in mid-April 1981, he was symptom-free for
almost three years. He felt in excellent health both emotionally and physically.
He stopped taking lithium on a trial basis, but he knew that it was available
to him if he needed it again. Knowing it was available was reassuring in itself.

In the movie Mad Love, the main character, Casey, suffered
from bipolar disorder. The scenes displayed her doing "very wild and crazy,"
things such as pulling a fire alarm at school, crying on the floor in a restaurant
bathroom, covering her boyfriend's (Matt) eyes while he was driving. Throughout
the movie you saw her condition progress. She tried to kill herself by overdosing
on pills. At the end of the movie, she held a gun in her mouth. The strange
thing was that her moods would swing from being very happy to being very depressed.
It was hard to detect at first that she suffered from a psychological problem,
but her boyfriend finally realized it after he had witnessed her behavioral
changes. At the end, he confronts her and makes her realize she has to stop
fighting this and realize that she can not do this on her own and she must
seek professional help. She needed to take medicine, which had to be monitored.

Kay Redfield Jamison suffered from bipolar disorder. She
tried for the longest time to avoid seeking help, and do it on her own. After
fighting her sickness without treatment for many long years, she finally gave
in. Dr. Kay Redfield Jamison experienced manic-depression firsthand. While
she was pursuing her career in academic medicine, she found herself succumbing
to the exhilarating highs and horrific depressions. Her disorder launched
into spending sprees, epidisodes of violence, and an attempted suicide. She
finally sought help and went on Lithium. Lithium had side effects that didn't
agree with her. She suffered from nausea, vomiting, inability to read, comprehend,
and remember what she read. She suffered blurred vision. It impaired her concentration,
attention span, and affected her memory. As soon as she felt stable again,
she lowered her lithium level. There were also times she stopped taking the
medicine because she wanted to be able to handle whatever difficultities that
came her way without having to rely upon medication. But she realized she
had to stay on Lithium because no matter what struggles she had had, it was
painfully clear that without it she would have been in a state hospital or
dead. The first time Kay lowered her intake of Lithium the effect was dramatic.
She felt as though she had been living in a cloud. " A few days after lowering
my does, I was walking in Hyde Park, along the side of the Serpentine, when
I realized that my steps were literally bouncier than they had been and that
I was taking in sights and sounds that previously had been filtered through
thick layeers of gause. The quacking of the ducks was more insistent, clearer,
and more intesnse; the bumps on the sidewalk were far more noticeable; I felt
more energetic and alive. Most significant, I could once again read without
effort. It was, in short, remarkable." The problem with lowering her dosage
of Lithium was that she still experienced the manias of high-flying exuberance
and cascading of ideas. Thereafter, came the black tiredness in which she
would be reminded that she had a horrific disease, one that could destroy
her. She realized that the extremes in her moods were clearly due to the lower
dosage of Lithium she was taking. She was finally convinced that a certain
intellectual steadiness was essential and desireable. She feels it is definitely
worth taking 300 miligrms of lithium a day. While she was going through the
whole ordeal of her illness, she was deeply skeptical that anyone who did
not have the illness could truly understand it or understand exactly how hard
it was to live with the disorder.

Depending on the degree in which a bipolar patient is affected
with the disorder, does he/she have to be treated with both Lithium and/or
other medications (such as anti-depressants)? In addition, does he/she need
to see a psychotherapist in order to function in our society? Or can a person
maintain a normal functional life by only receiving one without the other?
A person should not first start taking medication without being evaluated
by a psychiatrist. There is a vast majority of people who can overcome their
depression without drugs. But if they have a biological imbalance in conjunction
with psychological problems they need both medication and psychotherapy. Depending
on the severity of the person's condition (and each person's situation will
differ), medication may be necessary, so a person can at least function on
a daily basis and so that a therapist can evaluate them. If a person is in
a stage where they are too depressed or too manic can be very difficult for
the therapist to assess their condition. A lot of times a psychiatrist prescribes
medication so that a patient can be brought to a therapeutic level. Even if
people are being treated for depression, they are still uncomfortable sharing
this information with their family, employers or acquaintances due to the
risk of how they will be treated and perceived after people are aware of their
illness.

In medieval times, it was explained in terms of religious
and demonic explanation. During the Middle Ages, depressives were called witches.
Psychiatric interpretations and treatment of depression begun effectively
in 1793 by Philippe Pinel, a French physician. The next major advance in depression
was introduced by Freud in 1900. Freud believed that depression was related
to some childhood trauma, combined with a predisposed personality. According
to Freudian theory, depression is a function of guilt and hostility turned
toward the self. He believed that an organic and/or biochemical basis would
be found. Unfortunately depression and bipolar disorders are not socially
acceptable; therefore, there is a stigma attached to these disorders which
makes people feel too embarrassed to get help. Throughout history the mentally
ill have been tortured, scorned, and laughed at. Why were mental patients
treated so harshly?

There was, and still is, ignorance about the nature of mental
illness. Although progress is being made toward educating people to the physical
cause, it was and still is believed to be a "mental" problem. According to
Norman Endler, "we fear the unknown and reject the deviant. Studies in social
psychology have shown that the deviant is treated like an outcast". By making
the public aware of the nature and treatment, a lot of misery and suffering
can be alleviated and people can lead more productive lives. The government
and our society need to be more responsive and provide funding so that the
needs of depressives can be adequately met. There shouldn't be a stigma attached
to being a manic depressive. It is part of a medical condition. Bipolar disorder
and other mood disorders have been proven to be biological chemical imbalances.
This is an illness. It is an illness just like cancer, diabetes, heart conditions,
blood diseases, Parkinson's disease, etc. The point is that mood disorders
are medical problems that must be treated with medication and any other medical
treatments deemed necessary such as psychotherapy.

Unfortunately, the term mental illness has come to have
all kinds of negative connotations. Some of the myths are that people with
mental illnesses are dangerous, and that mental illness is incurable and that
these people should be institutionalized. Ignorance has led to a societal
stigma. People need to be educated. Psychological disorders needed to be recognized
as illnesses just like other illnesses. Insurance companies need to be forced
to treat mental illnesses just as they treat all other illnesses. Currently,
they discriminate against people who need treatment by not providing coverage
or by limiting the coverage that they reluctantly provide. The government
needs to take an active role in educating the public that depression and mood
disorders are illnesses. These illnesses are biological problems that have
been proven to be treatable. If the government gets involved and addresses
this problem, more people can get treatment and alleviate themselves from
the misery that they may be living in. They should not be embarrassed. A mood
disorder is an illness and with the proper treatment, it can be managed so
that a person can live a normal-functioning life. Knowing that our government
and society are supporting psychological disorders by educating them, this
will help affected people realize this is not something to be embarrassed
about and rather it is a treatable disease.

Seeking treatment has enormous benefits to affected individuals
and all of society. The negative attitudes toward mental illnesses needs to
be changed. Depression is a common pervasive illness affecting all social
classes and it has been proven to be treatable. There is no question that
it is a difficult illness to treat due to the stigma and side effects of the
medications. But the bottom line is that a person shouldn't be afraid or discouraged
to seek help because they are ashamed of their illness or that they are concerned
about how society will perceive them. It is a difficult task to convince someone
to seek help and it is difficult for an individual to admit that they need
held. There are certainly a lot of elements going against a person with this
disease. A great deal of heartbreak can be avoided by helping an individual
detect the illness and seek treatment. If he/she then refuses to get help,
is is a personal misfortune. However, if we as a society refuse to provide
adequate means for treatment, then it is a tragedy on us all.